BRCC Childcare Intake Form

Thank you for registering for childcare at BRCC. It’s our privilege to provide a safe environment for your children while you attend a study or focus group on Wednesday evenings.

Name

*

Email

*

This address will receive a confirmation email

Cell Phone

*

Group Study

*

Please select one option.

Authentic Manhood From Beginning to Forever Godly Men of the Bible The Gospel on the Ground New Testament Survey

Childcare available for children Birth - 4th grade. For questions, contact childcare@brookvilleroad.cc

Child 1 Name & Age

*

Child 2 Name & Age

Child 3 Name & Age

Child 4 Name & Age

Dates Childcare Needed:

*

Please select all that apply.

All January 31 February 7 February 14 February 21 February 28 March 6 March 13 April 3 April 10 April 17 April 24 May 1 May 8

Additional Information (food allergies, instructions, etc):

Description

Thank you for registering for childcare at BRCC. It’s our privilege to provide a safe environment for your children while you attend a study or focus group on Wednesday evenings.

Please Fix the Following

Close